Maternal and Neonatal Outcomes Across Female Genital Mutilation Types in Somalia: An Exploratory Analysis at a Tertiary Referral Hospital

Background: Type-specific evidence on maternal and neonatal outcomes associated with female genital mutilation (FGM) in Somalia remains limited. We explored selected outcomes in a tertiary referral hospital. Methods: This exploratory analysis used prospectively collected data from 30 May 2022 through January 2026. Recruitment depended on specialist obstetricians being available or on duty. FGM was assessed by genital examination at admission for delivery after consent. Planned elective cesarean deliveries were excluded. Of 371 cleaned episodes, 337 had documented FGM classification. Type IV was descriptive only. Binary logistic regression compared Types II and III with Type I, adjusting for age and parity, with additional gestational-age adjustment for the neonatal composite. Results: The classified sample included 23 women without FGM, 60 with Type I, 139 with Type II, 110 with Type III, and five with Type IV. Cesarean delivery was numerically highest in Type II (35.3%); maternal/obstetric complications (19.4%) and stillbirth or early neonatal death (7.3%) were highest in Type III. No statistically significant global differences were detected for these outcomes. No statistically significant adjusted associations were detected for Type II or III vs Type I. In the neonatal logistic model, the adjusted odds ratio per additional gestational week was 0.73 (95% confidence interval 0.64– 0.82). Conclusions: The selected outcomes showed no statistically significant adjusted associations for Types II or III compared with Type I. These exploratory findings do not establish equivalence or estimate FGM-associated risk relative to no FGM. Selection, imprecision, residual confounding, incomplete management data, and outcome-coding limitations constrain interpretation. Keywords: female genital mutilation, FGM, obstetric outcomes, neonatal outcomes, Somalia, exploratory analysis, prospectively collected data